Vermont Health Insurance Exchange Guide

Starting in 2014, as part of health care reform, health insurance coverage for individuals and small businesses will become available through new state health insurance exchanges. Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health premium subsidies) will only be available for coverage purchased through their state health insurance exchanges. 

Under health care reform, there will be an exchange (also called "marketplaces") in every state. All states have three options for setting up a state health insurance exchange for 2014:

1. Build a state-based exchange
2. Enter into a state-federal partnership exchange
3. Default to a federally-facilitated exchange

Vermont plans to offer a state-based  exchange that will open October 1, 2013 (for coverage starting January 1, 2014) under the name "Vermont Health Connect."

Vermont Health Insurance Exchange - What is it?

The Vermont Health Insurance Exchange will be a marketplace where Vermont individuals, families and small businesses can compare health plans and select a plan that fits their needs and budget. All plans offered through Vermont Health Insurance Exchange will by Qualified Health Plans (QHPs), meeting federal guidelines. According to Vermont Health Connect, the Exchange website will have easy-to-understand, side-by-side comparisons of plan’s costs and benefits.

The Vermont Health Insurance Exchange will also provide information on tax credits and public programs.  The Exchange will provide assistance to residents selecting a health plan or using the website by phone or in person.

The Vermont SHOP exchange will be available for small businesses with 50 or fewer employees starting in 2014. In 2016, small businesses with 100 or fewer employees will be able to offer coverage for their employees through Vermont's SHOP Exchange.

According to healthcare.gov, 44,105 or 8% of Vermont’s non-elderly residents are uninsured, of whom 37,179 (84% of these) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Vermont participates in the Medicaid expansion. Vermont currently supports Medicaid expansion.

Vermont Health Insurance Exchange - How was it Formed?

Vermont is approaching the health care reform differently than many other states. On May 26, 2011, Governor Peter Shumlin signed into law HB 202, a state health reform law that puts the state on a path toward establishing a single-payer health care system. As an interim step, the law created the Vermont Health Benefit Exchange to meet the requirements of federal health reform.

The state plans to offer a state-based exchange as part of federal health reform, and in 2017 the state plans to apply for a federal Waiver for State Innovation to transition to Green Mountain Care, the new public-private single-payer system that will provide coverage for all state residents. In May 2012, the Governor signed additional health system reform legislation further defining the role and duties of the Green Mountain Care Board and the Exchange (HB 559).

On January 3, 2013, Vermont received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a state-based exchange.

Vermont Health Insurance Exchange - What Plans will be Available?

Vermont has released preliminary premium rates on their website. The rates, which are subject to regulatory review, will range from $1,700 for premium family coverage to $745 for catastrophic coverage. For a single person, rates will range from $600 for premium coverage to $265 for catastrophic coverage. These rates do not take into account the premium tax credits that will be available to most individuals and families. 

Vermont Health Insurance Exchange - What is the Role of Brokers and Navigators?

According to the Vermont Health Insurance Exchange website, individuals and small businesses will be able use a broker to enroll in a health plan, whether it’s through the Vermont Health Insurance Exchange or through the private market. Individuals and businesses that use the Vermont Health Insurance Exchange to enroll in company health plans will have the option of using Navigators to walk them through the process. Both registered brokers and certified Navigators will be fully trained and certified by the Exchange.

According to the Vermont Health Insurance Exchange website, Vermont has received federal grant funding to subsidize traditional broker fee payments to support individuals and small businesses that want to continue their relationship with their broker. The funding may be utilized to subsidize broker assistance for small group employers with a January 1, 2014 renewal date. In January 2013, the State also received a federal grant to fund the Navigator program.

More details on the broker and navigator programs are expected by late summer 2013.